(by doylej15)

1.    The Author

  • Retired American Gastric Surgeon
  • Graduate of Yale University. Still teaches bioethics and history of medicine there.
  • Written quite a books, How we die being one of the most well-known.
  • A bit of a modern philosopher.

2. The book

  • In this book “How we die” he does literally go into the various ways in which how elderly people die but also not so much in this chapter how his grandmother whom he calls ‘bubbeh’ (grandmother in Jewish) and was obviously very close too, dies.
  • I later found out that he shared a room with his grandmum till he was 19 and she was in her 90s, and would be interested in reading about how he describes her journey to death and how it affected him because he seems to write very open and sincerely.
  • I found it an appealing read and was pleased to see that someone had put so much thought into this subject, the subject of dying.
  • As people going into the medical profession, it’s clearly a very significant subject and he talks about it in a natural way. This is refreshing to hear and I think as doctors he wants us and we should aspire to be able to confront the subject as he does.

3. How we die

  • He describes in detail the main ways in which the elderly die. He backs up his writing with statistics and illustrates the pathophysiology well. At times it has a danger of sounding like a text book but there are plenty of anecdotes which livens up the piece.
  • He talks about the two proposed theories of aging. The ‘Wear and Tear’ theory which emphasizes the progressive damage done to your body just by carrying out everyday functions. And the ‘genetic tape’ theory which proposes that ageing is determined by your genetic predisposition, the length of one’s life is already fixed and that the tape begins to run at the instant of contraception.
  • He supplements this with a nice quote from a 17th century figure Quarles who says ‘’It lies in the power of man, either permissively to hasten, or actively shorten his natural life.’’ Pg 70
  • This is where Nuland tries to make the point that life accomplishments make up in quality what life lacks in quantity.
  • Page 87 has a fantastic paragraph where Nuland is reflecting on this and says “When it is accepted that there are clearly defined limits to life, then life will be seen to have a symmetry as well. …The fact that there is a limited time to do the rewarding things in our lives is what creates the urgency to do them. Otherwise, we might stagnate in procrastination.”
  • He also leaves the best quote in my opinion to last, Montaigne- “The utility of living consists not in the length of days, but in the use of time; a man may have lived long, yet but lived but a little.”  It makes me think that as people in the medical profession, our initial reaction to someone dying is to try and keep them alive but we have no idea how ready they are to die. We don’t know if they are willing to go through suffering to cling on to life for a bit longer.
  • I think Nuland wants us to recognise that if we are reaching the limits of our natural life that the quality not quantity of our last days is in the doctors and patients priority.
  • He quotes his school professor of geriatric medicine Dr Cooney pg 71. He seems to hold geriatricians in very high regard because he sees them as the solution to the problem of the old family doctor who, in his words, knew his patients as well as he did his diseases.

4. Why we die

  • Nuland also questions why we die.
  • At first it seems like a stupid question and we brush it off, but if we actually try answering it, it is difficult and he discusses it very well. Using quotes from Homer *pg 73 and Thomas Jefferson  he makes us appreciate that again death is just as natural as life.

5.    Conclusion.

  • Another reason I enjoyed the text is because it got me thinking about death and what is would feel like and the journey towards it. It also got me thinking about euthanasia and whether our laws are correct in Ireland. Maybe we hesitate to pass such laws as we are afraid they will lead to more extreme laws.
  • So it was a thought provoking text and for that reason alone it is a worthwhile piece of writing and I could definitely see myself coming back to read the book at some point.
  • I’ll finish with a quote from Nuland which I think sums up want he wanted us to take from this chapter, it’s a quote taken from an interview with Yale Alumni magazine and he says “At the end, it is not the kindness of strangers we need, rather, it is the understanding of a long-time medical friend.” I think the ‘strangers’ are the surgeons, the pulmonologists rushing to dying elderly persons side to treat exactly what their blinkered view sees as wrong with them. The long-time family friend is the geriatrician who although may have only have met the person 2 weeks ago, has really known them for much longer.
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